Medical students asking a patient about death

Like any kid who always wanted to be a doctor, I went to medical school to learn how to help people. Just wearing the white coat during orientation week had people looking at me differently, expecting me to know something more than I did just a week before. One of my classmates was even asked for advice at a Dunkin Donuts.

One afternoon, about a month into school, half of our 100-person class entered a lecture hall donning our white coats for what some to us nonchalantly called “The Death Talk.” In a previous lecture, we listened to a professor interview a patient, who had a chronic illness and an organ transplant. We thought we were in for yet another lecture on doctor-patient communication.

I sat down quickly and realized that the only seat left was dead center and in the front row. I thought about moving so that I wouldn’t have to worry about my reactions to what the patient was about to tell us. I thought it was going to be really awkward. Maybe we’d make eye contact. Or worse, I would cry.

Waiting for the patient to begin her story, I started second-guessing what it meant to be a doctor. Sitting in a classroom day after day learning about the science behind the medicine, all I really wanted to do was learn clinical skills, and learn how to heal someone. I had not even talked to a patient about life, how could I ask one questions about death?

I was afraid that someone would notice that I was merely “acting the part.” As dying is not something you think about when you are a 20-something-year-old, and I often cry when daytime talk shows give a deserving family a car or money to start a new life, I did not know how to balance my emotions with my newfound professional capacity.

But boy was I wrong.

Surrounded on either side by two of her physicians, this 50-something restauranteur, eloquently explained the story of her illness. She told us that she was dying of colon cancer, which she learned about when she finally went to see a doctor. She had figured it was menopause making her gassy. Everything she went through in the hospital, the tests and treatments, was, to her, like being the star of a show, where she was performing to an audience of more than six doctors crowded around her bed (the stage). After that, nothing would ever embarrass her again, no indiscrete prodding and prying, and definitely no intensely personal questions. In fact, to lighten the mood while getting a radiation treatment, she applied a fake tattoo to one of her butt cheeks with the word “sexy” and told the doctor the new design was for him. Immediately with this joke, it was as if my classmates exhaled and realized that this talk would not be a depressing tale of death and dying, but instead, one of strength and survival.

Chemotherapy and radiation were tolerable, she said, but not the colostomy bag (or as she called it a “6 inch penis that grew in size as she went to the bathroom”) or the high-dose steroids that ballooned her to 190 pounds, up from 125. She told her doctors never again for these treatments. She wanted to do everything she could to preserve her best assets, her “brain and her ass.”

When she gave her first talk three years ago, doctors did not think she would make it another year. Just that fact that she is outliving their predictions made me realize the limits of modern medicine and the sheer resilience of patients.

I didn’t expect someone dying of cancer to look so healthy. If she had not passed around pictures of herself in different phases of her treatment, you would not have noticed that anything was wrong. She didn’t seem to dwell on her cancer. She didn’t seem to feel diseased. Even when the doctors told her the cancer had spread to her brain she went on a long planned trip to Italy with her 10 girlfriends.

Suddenly, my classmates were not afraid to ask her questions. Someone asked if she was scared. Another student asked her how she felt when she first found out she had metastatic cancer.

She responded that she wasn’t sad and that she never really felt fear. She said that perhaps this was because she worked with sick children at the Ronald McDonald house and felt luckier than them. She never asked “why me?”, she asked, “why not me.”

Another student asked her to describe what happened when the doctor first told her she was very sick. I think we were all looking to learn from her. We wanted to know what to do and what not to do as physicians in the future.

When her doctor told her the bad news, she said that he started to cry. She didn’t. I couldn’t believe it. “How did that make you feel?”, another student asked.

“I appreciated it,” she said. “It made me trust them more.”

Maybe I don’t need to worry about my hiding my emotions next time.

Jessica Gold is a medical student.

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Medical students asking a patient about death 6 comments

Death is definately a difficult topic to discuss, even for the most experienced physicians. Medicine has come a long way with respect to end of life issues. In the past, physicians viewed themselves as giving treatment until the very end, even if it was futile and pointless. As the field of Palliative Care Medicine has grown, more and more physicians have realized that alleviating the symptoms at the end of life is just as important as providing treatment to save life. I encourage you to speak to a physician in the field of Palliative Care Medicine or even do a rotation, and your view of death will change even more.